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Synagis in April?

sail123sail123 member
in Preemies

My pedi told me that none of his patients have been approved for an April synagis shot. Apparently the insurance companies have decided that the season ends April 1 in our area (NYC). My pedi disagrees and says my boys should get a shot in April. 

Is anyone else having issues with insurance over the April shot? If so, what did you do? We can't pay out of pocket, it is like $1500 a shot per kid.  

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Re: Synagis in April?

  • caitdanacaitdana member
    My girls get their last shot on the 29th and they said our insurance would not allow us to get one again until next season even though the dr would like us to get one again next month. We got the bill in the mail and it was 1100 a piece, so looks like we are waiting until next season...
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  • cara-n-stevecara-n-steve member
    We've been having the same problem.  Our pedi has been fighting with the insurance company to get them approved for another shot.  We're going to the pedi on Friday so we'll find out what's going on.
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  • Kate621Kate621 member

    RSV season ends May 1st here. Jack just got his last synagis on March 17th. Medicare (or maybe its Medicaid? I don't remember) is who decides when official RSV season ends. If they can't get another dose I'd just be extra vigilant about handwashing and such.

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  • njdcgirlnjdcgirl member
    My pedi has said the same as others. While they want to give and think it is needed in April insurance is denying all the claims. When I spoke to them last week they said they hadn't been denied yet by my insurance company they said not to hold my breath. We go back next week so I'll cheek again. It sucks!
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  • ruthiewithruthiewith
    We're currently battling insurance about this, he's supposed to get his shot next month too, but they want us to pay $1200 up front or they won't release the meds to the pedi.  What a pain!  It's covered by our insurance apparently, but we just have to pay for it first and get reimbursed.  I'm working with my HR rep to figure out what the deal is. 
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  • philkristiphilkristi member
    We are getting it April 14th...insurance already approved and ordered.  My pedi actually said my insurance company was the easiest company she has ever worked with.  She said she doesn't even have to call to get anything approved.  So I have been lucky with that.  She also said that they have seen alot of RSV later this year and definitely wants everyone she sees to get the April shot.  I would see if you can get them to approve it.  You know you would think Insurance companies would look at the cost of RSV shot versus a stay at the hospital! 
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